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      Presentación inusual del síndrome de Parsonage-Turner. Reporte de un caso Translated title: Unusual Presentation of Parsonage-Turner Syndrome. A Case Report

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          Abstract

          El síndrome de Parsonage-Turner es el término utilizado para describir una neuritis que incluye el plexo braquial, caracterizada por: dolor agudo, debilidad y amiotrofia. El trastorno es más común en los hombres y, aunque puede ocurrir a cualquier edad, es sumamente común en el grupo de edad de 20 a 50 años. Los antecedentes incluyen: infección no específica de las vías respiratorias superiores, enfermedad gripal, infecciones bacterianas, vacunación, neoplasia, causa compresiva, traumatismo u cirugía en las áreas cercanas al brazo afectado o el ejercicio intenso. Se describe el caso de un paciente de 39 años, en el que esta entidad se presentó de manera inusual, con predominio de afectación en músculos interóseos anteriores.

          Translated abstract

          Parsonage-Turner syndrome is the term used to describe a neuritis which includes the brachial plexus and is characterized by severe pain, weakness and amyotrophy. This disorder is more commonly presented in men and, although it can appear at any age, is it extremely common from 20 to 50 years old. Previous records include: nonspecific infection of the upper respiratory airway, flu, bacterial infections, vaccinations, neoplasia, compressive cause, trauma or surgery in the areas near the affected arm or intense exercise. The case of a male, 39 years old patient is described. In this patient, the entity’s presentation was very unusual. An affection of anterior interosseous muscles predominated.

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          Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis).

          Neuralgic amyotrophy (also know as Parsonage-Turner syndrome or brachial plexus neuritis) is a distinct peripheral nervous system disorder characterised by episodes (attacks) of extreme neuropathic pain and rapid multifocal weakness and atrophy in the upper limbs. Neuralgic amyotrophy has both an idiopathic and hereditary form, with similar clinical symptoms but generally an earlier age of onset and more episodes in the hereditary form. The current hypothesis is that the episodes are caused by an immune-mediated response to the brachial plexus. Recovery is slow, in months to years, and many patients are left with residual pain and decreased exercise tolerance of the affected limb(s). Anecdotal evidence suggests that corticosteroids may relieve pain or help improve functional recovery. The objective was to provide a systematic review of all randomised clinical trials of treatment in neuralgic amyotrophy. We searched the Cochrane Neuromuscular Disease Group Trials Register (April 2 2009), MEDLINE (January 1966 to April 2 2009), EMBASE (January 1980 to April 2 2009), CINAHL (January 1982 to April 2 2009), and LILACS (January 1982 to April 2 2009) for randomised controlled trials of treatment for neuralgic amyotrophy. Any randomised or quasi-randomised trial of any intervention for neuralgic amyotrophy would be included in the review. Two review authors extracted the data (RH, NvA) and two authors assessed study quality and performed data extraction independently (NvA, BvE). No randomised or quasi-randomised trials were identified. In 30 articles anecdotal evidence was found on treatment for neuralgic amyotrophy. Only three of these articles contained more than 10 treated cases, with one providing sufficient details to calculate the primary and secondary outcome measures for this review. At this moment there is no evidence from randomised trials on any form of treatment for neuralgic amyotrophy. Evidence from one open-label retrospective series suggests that oral prednisone given in the first month after onset can shorten the duration of the initial pain and leads to earlier recovery in some patients. Randomised clinical trials are needed to establish the efficacy of treatment with corticosteroids or other immune-modulating therapies.
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            Parsonage-Turner syndrome: MR imaging findings and clinical information of 27 patients.

            To review retrospectively the magnetic resonance (MR) imaging findings and clinical information of patients with Parsonage-Turner syndrome (PTS). The institutional review board did not require its formal approval or informed patient consent at the time of the study. However, the study was HIPAA compliant. The information in a computerized database of 2875 consecutive shoulder MR examinations was retrospectively reviewed. With use of key terms, the database software identified 81 examinations potentially associated with PTS. Both authors together reviewed the 81 imaging reports and the corresponding patients' medical records. In consensus, they made the diagnosis of PTS in 21 patients (two with bilateral involvement) on the basis of MR findings, electromyographic results, and clinical data. They also examined the data of an additional six patients (one with bilateral involvement) obtained from outside facilities. Ultimately, 30 shoulders of 27 patients (18 male, nine female; age range, 12-81 years; mean age, 41 years) were evaluated. The MR findings and clinical information (ie, regarding atrophy, pain, weakness, electromyographic results, neck and spine history, trauma, excessive overhead activity, recent surgery, vaccination, and illness) of all patients with PTS were reviewed. MR findings of diffuse high T2 signal intensity abnormality and fatty atrophy of muscles were evaluated to assess the pattern of nerve involvement. Structural causes (eg, ganglion cyst or other mass) of neurogenic high T2 signal intensity abnormality were excluded at MR imaging. Twenty-nine (97%) of 30 shoulders had suprascapular nerve involvement; in 15 (50%) shoulders, the involvement was limited to this nerve. Fifteen (50%) shoulders had axillary nerve involvement; in only one (3%) shoulder, the involvement was limited to this nerve. One shoulder (3%) had subscapular nerve involvement. Nine (30%) shoulders demonstrated focal muscular atrophy. Eleven (41%) of 27 patients also underwent electromyography; all of these patients demonstrated neuropathies that matched the patterns of neurogenic high T2 signal intensity abnormality seen at MR imaging. The suprascapular nerve was almost invariably involved (in 97% of shoulders) in patients with PTS. Axillary nerve involvement also was commonly observed (in 50% of shoulders). Subscapular nerve involvement was uncommon (in 3% of shoulders). RSNA, 2006
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              Evaluation of prednisolone treatment in the acute phase of neuralgic amyotrophy: an observational study.

              Effective treatment for neuralgic amyotrophy (NA), a disabling brachial plexus syndrome of supposed immunomediated origin, is currently lacking. Given the circumstantial evidence of a beneficial effect of prednisolone on pain and paresis, this report evaluates the effects of prednisolone treatment administered in the acute phase in a retrospective case series of 50 NA patients. Baseline variables (eg, age, sex, type of NA and number of attacks), treatment variables (eg, time until treatment, regimen and use of analgesics) and outcome measures (eg, duration and severity of pain, time course and severity of paresis and functional outcome) were statistically analysed and compared with a historical control group of 203 untreated NA patients. The baseline characteristics of the two patient groups were comparable. The median time until initial pain relief was lower in the study group (12.5 days vs 20.5 days), and a significantly higher percentage already recovered strength in the first month of treatment (18% vs 6.3%; p = 0.011). Twelve per cent had fully recovered within 1 year, while this was 1% for the controls (p<0.001), with the proportion reporting a "good" 12-month outcome also being higher (44% vs 10.7%; p<0.001). Side effects were reported by 20%, but none led to a discontinuation of treatment. Oral prednisolone seems effective in the acute phase of neuralgic amyotrophy with the current results supporting previous case reports. A regimen of oral prednisolone is therefore recommended in the acute phase of the syndrome pending a prospective, randomised trial verifying the results obtained.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                ms
                MediSur
                Medisur
                Facultad de Ciencias Médicas de Cienfuegos, Centro Provincial de Ciencias Médicas Provincia de Cienfuegos. (Cienfuegos )
                1727-897X
                December 2011
                : 9
                : 6
                : 576-578
                Affiliations
                [1 ] Hospital General Universitario Dr. Gustavo Aldereguía Lima Cuba
                Article
                S1727-897X2011000600010
                af074a6b-3ba9-48fc-b998-cd188365ae8e

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Cuba

                Self URI (journal page): http://scielo.sld.cu/scielo.php?script=sci_serial&pid=1727-897X&lng=en
                Categories
                HEALTH CARE SCIENCES & SERVICES

                Health & Social care
                brachial plexus neuritis,neuritis del plexo braquial
                Health & Social care
                brachial plexus neuritis, neuritis del plexo braquial

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